Claims Specialist-WC

HIRING NOW: Claims Specialist - Workers' Compensation (NEVADA)
Ready to make a real impact? We're looking for a sharp, proactive Claims Specialist-WC to join our team!

In This Role, You'll
⚡ Administer and resolve non-complex, short-term Workers' Compensation claims, including medical-only cases
⚡ Maintain accurate and up-to-date documentation while monitoring open claim inventory
⚡ Ensure timely and proper closure of claims in compliance with internal standards
⚡ Make claim decisions within delegated authority guidelines

If you're detail-driven, organized, and eager to grow in a fast-paced environment, you're exactly who we're looking for!

✨ Nevada residents - we want YOU!

Apply today and take the next big step in your WC career!


* College degree or the equivalent of education and experience.


* Knowledge of claims and familiarity with claims terminology gained through industry experience and/or through specialized courses of study (Associate in Claim designation, etc).


* Demonstrates a thorough working knowledge of claim processing and claim policies and procedures.


* Demonstrates an understanding of basic medical terminology and appropriate medical tests for claimed conditions


* Demonstrates effective and diplomatic oral and written communication skills.


* Demonstrates a customer-focused approach including the ability to identify and understand customer needs, and interacts effectively with others.


* Must have or secure and maintain the appropriate license(s) as required by the state(s) at the adjuster/supervisory/management level.

Must possess a valid driver's license.

Must complete continuing education requirements as outlined by Crawford Educational Services.

Additional courses may be required by jurisdiction for maintenance of license.

#LI-ET1


* Conducts investigations of claims to confirm coverage and to determine liability, compensability, and damages.

Works closely with claimants, witnesses and members of the medical profession and other persons pertinent to the investigation and processing of claims.


* Verifies policy coverage for submitted claims and notifies the insured of any issues; determines and establishes reserve requirements, adjusting reserves, as necessary, during the processing of the claim.


* Identifies wage loss expenses and wage exposures on medical claims.


* Documents receipt and contents of medical reports.

Interacts frequently with claimant to understand nature and extent of injury and medical conditions.

Reviews and handles other correspondence within authority including material from the team members, and/or clients.


* Approves payments of medical bills on lost time disability claims within area of payment authority up to, but not exceeding, $2,500 after compensability has been determined.


* Evaluates medical claims for potential fraud issues, loss control and recovery in accordance with insurance policy contracts, medical bill coding ...